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The Texas Rangers and their ace Jacob deGrom on Tuesday were hit with the news that the veteran right-hander will soon undergo Tommy John surgery on his throwing elbow and as a consequence miss the remainder of the 2023 season and at least a large chunk of 2024.

Needless to say, this is a substantial blow to the first-place Rangers, who this past offseason inked deGrom to a five-year, $185 million free-agent pact. deGrom when healthy has been the best pitcher in baseball for the last half-decade or so, but the problem is that he's rarely been healthy. Texas knew of those risks when they signed deGrom, but no one expected their worst fears to be realized this quickly. 

For deGrom, it's a sadly familiar blow, and in this instance it's very specifically familiar. deGrom originally underwent Tommy John surgery in 2010, and now he becomes one of those rare pitchers who will attempt to revive his career after having his elbow reconstructed multiple times. 

While going through the procedure a second time typically entails a longer recovery period and potentially lower odds of success, a number of hurlers have returned from a second TJ. For one example, deGrom need look no further than his Texas teammate Nathan Eovaldi. He underwent Tommy John in 2007 and then 2016, and this season at age 33 he's been one of the best pitchers in all of baseball. Other prominent examples of successful comebacks from double TJ include Jameson Taillon, Daniel Hudson, Jason Isringhausen, Chris Capuano, and Joakim Soria. Two current moundsmen – Hyun-Jin Ryu of the Blue Jays and Walker Buehler of the Dodgers – will attempt to join those ranks soon enough. 

What stands out about deGrom is the length of time between surgeries – 13 years or so. Of the more 40 pitchers to undergo Tommy John more than once (data via Jon Roegele), just five have seen a gap as long as or longer than deGrom's between procedures. Those are the aforementioned Ryu (18 years between TJs), former MLB reliever John Axford (18 years ), current MLB reliever Kirby Yates (15 years), former MLB reliever Todd Coffey (13 years), and current MLB reliever Matt Bush (13 years). Of those, two have made it back (Bush and Yates), two never returned to MLB (Axford and Coffey), and one's return is pending (Ryu). 

In Axford's case, he was 38 years of age at the time of his procedure, so he may not have been long for the majors anyway. Coffey's failure to make it back is perhaps more illuminating, as he was in his early thirties at the time of his second procedure. However, he had been a below-average reliever for three years running leading up to it. As for the two who made it back, some quick numbers … 

Matt Bush

  • Before second TJ: Age 30-32, 136 relief appearances, 3.35 ERA/141 ERA+, 2.94 K/BB ratio
  • After second TJ: Age 35-37, 72 relief appearances, six starts, 4.16 ERA/98 ERA+, 3.48 K/BB ratio

Kirby Yates

  • Before second TJ: Age 27-33, 291 relief appearances, 3.54 ERA/115 ERA+, 4.26 K/BB ratio 
  • After second TJ: Age 35-36, 29 relief appearances, 3.76 ERA/118 ERA+, 1.55 K/BB ratio

Call it a mixed bag, and it's of course impossible to tell what's age-related decline and what's a function of undergoing a second TJ. On the positive side, Bush has been better from a command-and-control standpoint since returning, and Yates has been better from a (park- and league-adjusted) run-prevention standpoint. These two names up top should show deGrom that a return to quality form is indeed possible. 

As for Ryu, perhaps he's the best model. He's a starting pitcher with a substantial injury history who in the past pitched at an All-Star level, and he's 36 years of age – the likely age deGrom will be when he returns to the mound. Ryu has been throwing from it for some time, and at last report he's angling for a return to the Toronto rotation not long after the All-Star break. The path forward for Ryu, because of those noted similarities, could be instructive for deGrom. The lesson remains that what's ahead for deGrom is difficult but far from impossible.